Provider Demographics
NPI:1437281979
Name:WILLIAMS, ROSALIND J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:626-639-3005
Practice Address - Street 1:445 E ANAHEIM ST STE H
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4600
Practice Address - Country:US
Practice Address - Phone:310-518-6146
Practice Address - Fax:877-469-1428
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13988363AM0700X
CAPA13988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01272669/DU4032OtherRAILROAD MEDICARE
CAEFF: 4/23/13 L BCHMedicaid
CAP01272669/DU4032OtherRAILROAD MEDICARE
CAHD867ZMedicare PIN